Attention deficit hyperactivity disorder symptoms, type of offending and recidivism in a prison population: The role of substance dependence.

BACKGROUND: It is unclear whether adult offenders with a history of attention deficit hyperactivity disorder (ADHD) are more likely to re-offend, and if so, in any specific offences. AIM: This study aimed to examine correlates of childhood ADHD symptoms among prisoners. METHODS: A randomly selected sample of 1179 participants from the adult sentenced population of Puerto Rico (USA) reported their history of violent and non-violent offences, age of first arrest and re-offending. Participants completed retrospective measures of ADHD and a diagnostic interview for substance use disorders. RESULTS: Self-reported ADHD was associated with age of first arrest, a number of violent and non-violent offences and re-offending. The association with any non-violent offending was explained statistically by substance use disorders and other psychosocial covariates. ADHD was independently associated with being under 15 years of age at first arrest and with re-offending. CONCLUSIONS: Although some associations between ADHD and offending may be accounted for by co-morbidity with substance use disorders, early onset of offending and repeated violent offending appear to be directly related to ADHD. Criminal justice policies should, therefore, incorporate ADHD screening accompanied by appropriate rehabilitation programmes when such neurodevelopmental disorder is identified. Copyright © 2016 John Wiley & Sons, Ltd.

Genetic variants of the drug-metabolizing enzyme CYP2D6 in Puerto Rican psychiatry patients: a preliminary report and potential implications for breast cancer patients.

BACKGROUND: The CYP2D6 liver enzyme, which metabolizes 25-30% of common medications, is highly polymorphic. Existing studies of Hispanics have focused on Mexicans and Mexican-Americans. The goal of the study was to identify the CYP2D6 alleles associated with reduced or negligible activities present in the Puerto Rican population. METHODS: The study cohort comprised 40 Puerto Rican psychiatric patients referred because of suspected intolerance of drugs metabolized by CYP2D6, and five subjects without suspected adverse responses to these drugs. All subjects had both parents and all grandparents born in Puerto Rico. Genomic DNA was queried for 27 CYP2D6 alleles using the Roche AmpliChip P450 test. RESULTS: A total of 12 alleles were identified. The most common alleles were CYP2D6*1 > *2 > *4 > *41. The inactive alleles were *4 > * 5 > * 31 >*40; reduced activity alleles were *10 >* 17 > *9* = *29; active alleles were *1 > *2 > *35. Two subjects carried the rare *31 allele. Only one subject carried two non-functional alleles (CYP2D6*5/*40), and was predicted to be a poor metabolizer. CONCLUSIONS: Any conclusions should be interpreted with caution given the small population sample investigated. Nonetheless, our findings strongly suggest that Puerto Ricans exhibit distinct CYP2D6 allele frequencies and harbor a non-functional allele that is rare or absent in other populations and are highly valuable for the emerging practice of Personalized Medicine in admixed populations like Puerto Ricans.

Discovery of the nonfunctional CYP2D6 31 allele in Spanish, Puerto Rican, and US Hispanic populations.

BACKGROUND: CYP2D6 31 (4042G>A, R(440)H) is an allelic variant of the highly polymorphic cytochrome P450 2D6 enzyme that has been associated with reduced functional activity. The US Food and Drug Administration (FDA)-cleared AmpliChip CYP450 test detects the 4042G>A single nucleotide polymorphism (SNP) but an allele assignment could not be made in two Spanish and two Puerto Rican individuals heterozygous for 4042G>A, resulting in no-calls. We aimed to resolve the CYP2D6 31 no-calls, determine the allele haplotype, and corroborate that CYP2D6 31 is associated with a poor metabolizer phenotype. METHODS: CYP2D6 genotyping was carried out using the AmpliChip CYP450 test and long-range polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP) platforms. Allele haplotype was determined by cloning and sequence analysis. Allele frequencies were determined in five population samples. RESULTS: A 6.6-kb long-range PCR product comprising the entire CYP2D6 gene and flanking regions was sequenced to determine the CYP2D6 31 haplotype. Identical sequences were obtained from both Puerto Ricans selected for sequence analysis. One Spanish individual with a CYP2D6 4/31 genotype was phenotyped as a poor metabolizer with the CYP2D6 probe drug dextromethorphan (urinary ratio DM/DX=0.71). The frequency of CYP2D6 31 was determined in 176 Spanish (0.57%), 50 Puerto Rican (2.0%), and 150 Hispanic (0.33%) people. CYP2D6 31 was absent in 237 North American Caucasians and 154 African Americans. CONCLUSIONS: CYP2D6 31 was associated with poor metabolism of dextromethorphan in vivo, which is consistent with a previous report classifying this allelic variant as nonfunctional. The discovery of CYP2D6 31 in Spanish people only (or of Spanish ancestry) suggests that it may contribute to CYP2D6 variability in individuals of Spanish ancestry.

Attention deficit hyperactivity disorder in five schools of the San Juan metropolitan area: assesment of teacher's knowledge.

OBJECTIVES: The purpose of this study was to explore the level of knowledge that a group of Puerto Rican teachers have about Attention Deficit Hyperactivity Disorder (ADHD), the most common psychiatric disorder in school age children. METHOD: the design was descriptive experimental. One hundred thirty two school teachers of five different schools (public and private) from the metropolitan area of San Juan participated in the study. Questionnaires administered included demographic data of participants; 29 true or false questions, (obtained from the DSM-IV TR diagnostic criteria of ADHD and other behavioral disorders); and five 'vignettes' of children with common behavioral problems observed in the classroom. Logistic regression was used in the analysis of data. RESULTS: Thirty five per cent of the teachers reported to have had previous knowledge about ADHD. Seventy two per cent (72) reported a low level of knowledge about the disorder as reflected on the true/false section, while 60% were able to identify two out of three vignettes of children with characteristics of ADHD. No statistically significant correlation was found between teachers' level of knowledge and other variables studied (age, gender, college where obtained the degree, years of experience, the level they teach or previous training obtained about ADHD). DISCUSSION: The findings evidence the limited information and confusion that teachers have about ADHD. A thorough revision of the curricular content of teachers in training is recommended so that they become knowledgeable about the common behavioral problems that commonly affect children. Teachers' observations are important sources of information for child psychiatrists in the process of evaluation and diagnosing children with ADHD. Therefore, is critical that teachers in the public and private sectors become aware of these characteristics so they are able to identify these children as early as possible.

Examining minor and major depression in adolescents.

BACKGROUND: Research has shown that a large proportion of adolescents with symptoms of depression and substantial distress or impairment fail to meet the diagnostic criteria for a major depressive disorder (MDD). However, many of these undiagnosed adolescents may meet criteria for a residual category of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revised (DSM-IV-TR), Depressive Disorder Not Otherwise Specified. Minor Depression (mDEP), an example of one of these categories, allows the inclusion of sub-threshold cases that fall below the diagnostic criteria of the five symptoms required for MDD. Minor depression in adolescence is important because it is significantly related to MDD in adulthood. The present study examines a number of risk factors, functional impairment, comorbidity and service utilization patterns associated with depression in community adolescents who met the DSM-IV criteria for mDEP and compares their profile to adolescents who met the criteria for MDD. METHOD: Puerto Rican adolescents 11 to 17 years old were selected from an island-wide probability household sample of children ranging in age from 4 to 17. The Diagnostic Interview Schedule in Spanish (DISC IV), together with a structured protocol of risks and protective factors, and service utilization questionnaires were administered to primary caretakers and their children. RESULTS: Our findings indicate that youngsters with mDEP had significant impairment and used more mental health services than those with major depression. In addition, adolescents with mDEP had similar outcomes when compared to those meeting full criteria for MDD in terms of psychosocial correlates and comorbidity. CONCLUSIONS: The results, although not definitive, suggest a need for further research in order to determine the validity of the present DSM IV diagnostic criteria for mDEP in adolescents.

Applicability of the Spanish Translation of the Zung Self-Rating Depression Scale in a general Puerto Rican population.

Voluntary screening has shown to be an effective way to identify depressive symptoms and to provide adequate treatment. If a screening tool was to be used in a general Puerto Rican population, it should be validated in Spanish and be consistent with the particular response style of this group. The main objective of this research study is to assess if the Spanish translation of the Zung SDS is adequate to screen for depression in Puerto Ricans, and if the translation considers the sociocultural peculiarities of this group. Although the Zung SDS is presented as a self-report scale and was found to be reliable by Alpha coefficient and manageable by both the questioner and the participant, the Spanish version used in this activity presented interpretation difficulties. It is recommendable that a Spanish translation of this scale should be developed taking into consideration the particularities of the Puerto Rican population. The use of other screening tools that have already been validated as being culturally sensitive to Puerto Ricans could also be considered.